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1.
Yu Mi Lee Kyu Chan Huh Soon Man Yoon Byung Ik Jang Jeong Eun Shin Hoon Sup Koo Yunho Jung Sae Hee Kim Hee Seok Moon Seung Woo Lee Daejeon-Chungchung Intestinal Research Group 《Gut and liver》2016,10(2):250-254
Background/Aims
To determine the incidence and clinical characteristics of tuberculosis (TB) medication-associated Clostridium difficile infection.Methods
This multicenter study included patients from eight tertiary hospitals enrolled from 2008 to 2013. A retrospective analysis was conducted to identify the clinical features of C. difficile infection in patients who received TB medication.Results
C. difficile infection developed in 54 of the 19,080 patients prescribed TB medication, representing a total incidence of infection of 2.83 cases per 1,000 adults. Fifty-one of the 54 patients (94.4%) were treated with rifampin. The patients were usually treated with oral metronidazole, which produced improvement in 47 of the 54 patients (87%). Twenty-three patients clinically improved with continuous rifampin therapy for C. difficile infection. There were no significant differences in improvement between patients treated continuously (n=21) and patients in whom treatment was discontinued (n=26).Conclusions
The incidence of C. difficile infection after TB medication was not low considering the relatively low TB medication dosage compared to other antibiotics. It may not be always necessary to discontinue TB medication. Instead, decisions concerning discontinuation of TB medication should be based on TB status. 相似文献2.
Clostridium difficile, an anaerobic toxigenic bacterium, causes a severe infectious colitis that leads to significant morbidity and mortality worldwide. Both enhanced bacterial toxins and diminished host immune response contribute to symptomatic disease. C. difficile has been a well-established pathogen in North America and Europe for decades, but is just emerging in Asia. This article reviews the epidemiology, microbiology, pathophysiology, and clinical management of C. difficile. Prompt recognition of C. difficile is necessary to implement appropriate infection control practices. 相似文献
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4.
María E Negrón Herman W Barkema Kevin Rioux Jeroen De Buck Sylvia Checkley Marie-Claude Proulx Alexandra Frolkis Paul L Beck Levinus A Dieleman Remo Panaccione Subrata Ghosh Gilaad G Kaplan 《Journal canadien de gastroenterologie》2014,28(7):373-380
BACKGROUND:
The impact of Clostridium difficile infections among ulcerative colitis (UC) patients is well characterized. However, there is little knowledge regarding the association between C difficile infections and postoperative complications among UC patients.OBJECTIVE:
To determine whether C difficile infection is associated with undergoing an emergent colectomy and experiencing postoperative complications.METHODS:
The present population-based case-control study identified UC patients admitted to Calgary Health Zone hospitals for a flare between 2000 and 2009. C difficile toxin tests ordered in hospital or 90 days before hospital admission were provided by Calgary Laboratory Services (Calgary, Alberta). Hospital records were reviewed to confirm diagnoses and to extract clinical data. Multivariate logistic regression analyses were performed among individuals tested for C difficile to examine the association between C difficile infection and emergent colectomy and diagnosis of any postoperative complications and, secondarily, an infectious postoperative complication. Estimates were presented as adjusted ORs with 95% CIs.RESULTS:
C difficile was tested in 278 (58%) UC patients and 6.1% were positive. C difficile infection was associated with an increased risk for emergent colectomy (adjusted OR 3.39 [95% CI 1.02 to 11.23]). Additionally, a preoperative diagnosis of C difficile was significantly associated with the development of postoperative infectious complications (OR 4.76 [95% CI 1.10 to 20.63]).CONCLUSION:
C difficile diagnosis worsened the prognosis of UC by increasing the risk of colectomy and postoperative infectious complications following colectomy. Future studies are needed to explore whether early detection and aggressive management of C difficile infection will improve UC outcomes. 相似文献5.
The rising incidence of Clostridium difficile (C. difficile) infection or CDI is now a problem of pandemic proportions. The NAP1 hypervirulent strain of C. difficile is responsible for a majority of recent epidemics and the widespread use of fluoroquinolone antibiotics may have facilitated the selective proliferation of this strain. The NAP1 strain also is more likely to cause severe and fulminant colitis characterized by marked leukocytosis, renal failure, hemodynamic instability, and toxic megacolon. No single test suffices to diagnose severe CDI, instead; the clinician must rely on a combination of clinical acumen, laboratory testing, and radiologic and endoscopic modalities. Although oral vancomycin and metronidazole are considered standard therapies in the medical management of CDI, recently it has been demonstrated that vancomycin is the more effective antibiotic in cases of severe disease. Moreover, early surgical consultation is necessary in patients who do not respond to medical therapy or who demonstrate rising white blood cell counts or hemodynamic instability indicative of fulminant colitis. Subtotal colectomy with end ileostomy is the procedure of choice for fulminant colitis. When applied to select patients in a judicious and timely fashion, surgery can be a life-saving intervention. In addition to these therapeutic approaches, several investigational treatments including novel antibiotics, fecal bacteriotherapy and immunotherapy have shown promise in the care of patients with severe CDI. 相似文献
6.
The toxin-producing bacterium C. difficile is the leading cause of antibiotic-associated colitis, with an estimated 500,000 cases C. difficile infection (CDI) each year in the US with a cost approaching 3 billion dollars. Despite the significance of CDI, the pathogenesis of this infection is still being defined. The recent development of tractable murine models of CDI will help define the determinants of C. difficile pathogenesis in vivo. To determine if cefoperazone-treated mice could be utilized to reveal differential pathogenicity of C. difficile strains, 5-8 week old C57BL/6 mice were pretreated with a 10 d course of cefoperazone administered in the drinking water. Following a 2-d recovery period without antibiotics, the animals were orally challenged with C. difficile strains chosen to represent the potential range of virulence of this organism from rapidly fatal to nonpathogenic. Animals were monitored for loss of weight and clinical signs of colitis. At the time of harvest, C. difficile strains were isolated from cecal contents and the severity of colitis was determined by histopathologic examination of the cecum and colon. Cefoperazone treated mice challenged with C. difficile strains VPI 10463 and BI1 exhibited signs of severe colitis while infection with 630 and F200 was subclinical. This increased clinical severity was correlated with more severe histopathology with significantly more edema, inflammation and epithelial damage encountered in the colons of animals infected with VPI 10463 and BI1. Disease severity also correlated with levels of C. difficile cytotoxic activity in intestinal tissues and elevated blood neutrophil counts. Cefoperazone treated mice represent a useful model of C. difficile infection that will help us better understand the pathogenesis and virulence of this re-emerging pathogen. 相似文献
7.
Clostridium difficile infection (CDI) arises in the setting of antibiotic administration where disruption of the normal indigenous gut microbiota leads to susceptibility to C. difficile colonization and colitis. Using a murine model of CDI, we demonstrate that changes in the community structure of the indigenous gut microbiota are associated with the loss of colonization resistance against C. difficile. Several antibiotic regimens were tested in combination for the ability to overcome colonization resistance, including a five antibiotic cocktail consisting of kanamycin, gentamicin, colistin, metronidazole, and vancomycin administered in drinking water for three days, a single intraperitoneal dose of clindamycin or 10 days of cefoperazone in drinking water. Following antibiotic treatment animals were challenged with 105 colony forming units of C. difficile strain VPI 10463 via oral gavage. Animals that received the antibiotic cocktail and clindamycin prior to C. difficile challenge followed one of two clinical courses, either becoming clinically ill and moribund within 2-4 days post challenge, or remaining clinically well. Animals that became clinically ill developed histologically severe colitis. These histopathologic findings were significantly less severe in animals that remained clinically well. Analysis of 16S rRNA gene sequences retrieved from gut tissue at necropsy demonstrated that Proteobacteria dominated the gut microbiota in clinically ill animals. In contrast, the gut microbial community of clinically well animals more closely resembled untreated animals, which were dominated by members of the Firmicutes. All animals that received cefoperazone treatment prior to C. difficile challenge were clinically ill and moribund by 2-5 days post challenge in a dose dependent manner. The gut communities in these animals were dominated by C.difficile suggesting that cefoperazone treatment resulted in a greater loss in colonization resistance. Thus, the severity of colitis that arises in this system reflects the interplay between the expansion of C. difficile in the gut community and the ecologic dynamics of the indigenous microbial community as it recovers from antibiotic perturbation. We demonstrate that altering the balance of these two opposing processes alters clinical outcome and thus may lead to novel preventative and therapeutic approaches for CDI. 相似文献
8.
Tae-Geun Gweon Kyung Jin Lee Donghoon Kang Sung Soo Park Kyung Hoon Kim Hyeonjin Seong Tae-Hyun Ban Sung Jin Moon Jin Su Kim Sang Woo Kim 《Gut and liver》2015,9(2):247-250
Toxic megacolon is a rare clinical complication of fulminant Clostridium difficile infection. The mortality rate of fulminant C. difficile infection is reported to be as high as 50%. Fecal microbiota transplantation is a highly effective treatment in patients with recurrent or refractory C. difficile infection. However, there are few published articles on the use of such transplantation for fulminant C. difficile infection. Here, we report on a patient with toxic megacolon complicated by C. difficile infection who was treated successfully with fecal microbiota transplantation. 相似文献
9.
Marie Céline Zanella Terrier Martine Louis Simonet Philippe Bichard Jean Louis Frossard 《World journal of gastroenterology : WJG》2014,20(23):7416-7423
Clostridium difficile infections (CDI) are a leading cause of antibiotic-associated and nosocomial diarrhea. Despite effective antibiotic treatments, recurrent infections are common. With the recent emergence of hypervirulent isolates of C. difficile, CDI is a growing epidemic with higher rates of recurrence, increasing severity and mortality. Fecal microbiota transplantation (FMT) is an alternative treatment for recurrent CDI. A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach. FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI. Since the first reported use of FMT for recurrent CDI in 1958, systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment. This article focuses on current guidelines for CDI treatment, the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy, adverse effects and acceptability. 相似文献
10.
Andrada Seicean Anca Moldovan-Pop Radu Seicean 《World journal of gastroenterology : WJG》2014,20(17):5135-5140
The incidence of Clostridium difficile(C.difficile)infection(CDI)is 1.8%-5.7%in admitted patients with ulcerative colitis(UC).CDI can worsen UC and increase the risk for colectomy or even death,thus necessitating therapy escalation,such as increasing the corticoid therapy or starting a biologic treatment.Several reported cases with infliximab therapy have provided favorable outcomes in UC patients with CDI,suggesting that infliximab treatment may be protective;however,the optimal infliximab treatment regimen for UC patients with CDI remains to be established.Here,we report a case of worsening UC in the presence of recurrent CDI.The patient had received prior ciprofloxacin and immunosuppressive therapy during a prolonged hospital stay.The deterioration in the patient’s condition likely resulted from the ability of C.difficile to promote relapsing of UC by activating the immune response.Ultimately,the patient was treated with a high dose of infliximab after a low trough level of infliximab at week 8was identified,yielding better clinical results.Infliximab was found to be safe after repetitive episodes of CDI.The trough level of infliximab was therefore a useful indicator to guide therapy and correlated well with the patient’s outcome. 相似文献
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12.
Epidemiology of Clostridium difficile Infection in a Large Population of Hospitalized US Military Veterans 总被引:2,自引:0,他引:2
The Patient Treatment File (PTF) of the Department of Veterans Affairs (VA) comprises the computerized records of all inpatients treated at all VA hospitals throughout the United States. The database was utilized to study the clinical epidemiology and impact of C. difficile colitis on health care among hospitalized US military veterans. The computerized medical records of 15,091 cases with C. difficile colitis and 61,931 controls without the diagnosis were extracted from the annual files between 1993 and 1998. Of all patients admitted to the hospital, 1% were diagnosed with C. difficile colitis, in 16% of whom it was listed as the primary discharge diagnosis. C. difficile colitis was more likely to occur in elderly white patients with multiple comorbid conditions. Compared with a control population of hospitalized patients without C. difficile colitis, the case population was subjected to more medical and surgical procedures and experienced longer hospital stays. The diagnosis of C. difficile colitis was associated with more frequent admissions to the intensive care unit and higher hospital-related and subsequent mortality. Eleven percent of the cases were admitted to hospital a second time after a mean of 202 days, 2.5% were readmitted a third time after an additional 182 days, and 0.8% were readmitted a fourth time after an additional 194 days. In conclusion, as old age, multiple comorbid conditions, a high number of medical and surgical intervention, and long hospitalization constitute the main risk factors for the development of C. difficile colitis, efforts at prevention should be directed primarily towards patients who present with these characteristics. 相似文献
13.
Bo Kyung Yang Byung Ju Do Eun Jung Kim Ji Un Lee Mi Hee Kim Jin Gu Kang Hyoung Su Kim Kyung Ho Kim Myoung Kuk Jang Jin Heon Lee Hak Yang Kim Woon Geon Shin 《Gut and liver》2014,8(1):41-48
Background/Aims
As the incidence rate of and mortality from pseudomembranous colitis (PMC) are increasing worldwide, it is important to study the simple predictive risk factors for PMC among patients with hospital-acquired diarrhea (HAD). This study focused on identifying the clinical risk factors that can easily predict PMC.Methods
The presumed HAD patients were prospectively recruited at the Hallym University Kangdong Sacred Heart Hospital.Results
Age of 70 and older (adjusted odds ratio [OR], 1.76; 95% confidence interval [CI], 1.12 to 0.75), use of proton pump inhibitors (adjusted OR, 4.07; 95% CI, 2.512 to 6.57), use of cephalosporins (adjusted OR, 2.99; 95% CI, 1.82 to 4.94), and underlying cancer (adjusted OR, 1.72; 95% CI, 1.04 to 2.82) were independent risk factors for PMC in the multivariate logistic regression analysis. The prevalence of PMC was very low in the patients with HAD who exhibited no risk factors.Conclusions
The risk factors for PMC in patients with HAD included cephalosporin use, proton pump inhibitor use, old age, and cancer. Considering the strongly negative predictive values of these risk factors, endoscopic evaluation can be delayed in patients with HAD without risk of developing PMC. 相似文献14.
BACKGROUND:
The incidence and severity of Clostridium difficile infections are increasing, and there is a need to optimize the prevention of complicated disease.OBJECTIVE:
To identify modifiable processes of care associated with an altered risk of C difficile complications.METHODS:
A retrospective cohort study (with prospective case ascertainment) of all C difficile infections during 2007/2008 at a tertiary care hospital was conducted.RESULTS:
Severe complications were frequent (occurring in 97 of 365 [27%] C difficile episodes), with rapid onset (median three days postdiagnosis). On multivariable analysis, nonmodifiable predictors of complications included repeat infection (OR 2.67), confusion (OR 2.01), hypotension (OR 0.97 per increased mmHg) and elevated white blood cell count (OR 1.04 per 109 cells/L). Protection from complications was associated with initial use of vancomycin (OR 0.24); harm was associated with ongoing use of exacerbating antibiotics (OR 3.02).CONCLUSION:
C difficile infections often occur early in the disease course and are associated with high complication rates. Clinical factors that predicted a higher risk of complications included confusion, hypotension and leukocytosis. The most effective ways to improve outcomes for patients with C difficile colitis are consideration of vancomycin as first-line treatment for moderate to severe cases, and the avoidance of unnecessary antibiotics. 相似文献15.
Monika Wagner Louis Lavoie Mireille Goetghebeur 《The Canadian Journal of Infectious Diseases & Medical Microbiology》2014,25(2):87-94
BACKGROUND:
Clostridium difficile infection (CDI) represents a public health problem with increasing incidence and severity.OBJECTIVE:
To evaluate the clinical and economic consequences of vancomycin compared with fidaxomicin in the treatment of CDI from the Canadian health care system perspective.METHODS:
A decision-tree model was developed to compare vancomycin and fidaxomicin for the treatment of severe CDI. The model assumed identical initial cure rates and included first recurrent episodes of CDI (base case). Treatment of patients presenting with recurrent CDI was examined as an alternative analysis. Costs included were for study medication, physician services and hospitalization. Cost effectiveness was measured as incremental cost per recurrence avoided. Sensitivity analyses of key input parameters were performed.RESULTS:
In a cohort of 1000 patients with an initial episode of severe CDI, treatment with fidaxomicin led to 137 fewer recurrences at an incremental cost of $1.81 million, resulting in an incremental cost of $13,202 per recurrence avoided. Among 1000 patients with recurrent CDI, 113 second recurrences were avoided at an incremental cost of $18,190 per second recurrence avoided. Incremental costs per recurrence avoided increased with increasing proportion of cases caused by the NAP1/B1/027 strain. Results were sensitive to variations in recurrence rates and treatment duration but were robust to variations in other parameters.CONCLUSIONS:
The use of fidaxomicin is associated with a cost increase for the Canadian health care system. Clinical benefits of fidaxomicin compared with vancomycin depend on the proportion of cases caused by the NAP1/B1/027 strain in patients with severe CDI. 相似文献16.
Clostridium difficile TcdB harbors a glucosyltransferase that targets host Rho GTPases. However, the role of the enzyme activity in the induction of host intestinal disease has not been demonstrated. In this study, we established a mouse acute intestinal disease model by cecum injection of wild type and glucosyltransferase-deficient TcdB and a chronic model by delivering toxin intraluminally via engineered surrogate host Bacillus megaterium. We demonstrated, for the first time, that the glucosyltransferase activity of TcdB is essential for inducing disease symptoms and intestinal pathological responses that resemble human disease, highlighting the importance of targeting toxin glucosyltransferase activity for future therapy. 相似文献
17.
Models of Clostridium difficile infection (C. difficile) have been used extensively for Clostridium difficile (C. difficile) research. The hamster model of C. difficile infection has been most extensively employed for the study of C. difficile and this has been used in many different areas of research, including the induction of C. difficile, the testing of new treatments, population dynamics and characterization of virulence. Investigations using in vitro models for C. difficile introduced the concept of colonization resistance, evaluated the role of antibiotics in C. difficile development, explored population dynamics and have been useful in the evaluation of C. difficile treatments. Experiments using models have major advantages over clinical studies and have been indispensible in furthering C. difficile research. It is important for future study programs to carefully consider the approach to use and therefore be better placed to inform the design and interpretation of clinical studies. 相似文献
18.
Joseph Dylewski 《The Canadian Journal of Infectious Diseases & Medical Microbiology》2011,22(2):e12-e15
BACKGROUND:
The recent increase in Clostridium difficile-associated diarrhea (CDAD) has led to questions about the reproducibility and sensitivity of C difficile toxin testing (CDTT). While there have been recommendations to repeat CDTT following a negative result, previous studies have failed to show a benefit. However, no studies were performed during an outbreak of CDAD. The value of repeat CDTT after an initial negative result in patients tested during and after an outbreak of CDAD is reported in the present study, as well as the reproducibility of CDTT when multiple samples are received and tested on the same day.METHODS:
The results of CDTT, performed using a cell cytotoxicity assay between April 1, 2001, and March 31, 2008, were retrieved and searched for patients who had repeat samples tested after an initial negative result. The result and the number of days after a negative result were determined using the date of the most recent negative test. The cumulative positivity rate was calculated by adding all of the repeat positive test results for the days in question and dividing by the total number of tests performed during that time.RESULTS:
A total of 8661 patients submitted 14,991 stool specimens for CDTT during the study period. There were 3095 samples that tested positive (20.6%) for the toxin. The results were divided into two time periods to reflect the CDAD outbreak, which began in April 2002: period 1 (outbreak) was from April 1, 2002, to March 31, 2006, and period 2 was from April 1, 2006, to March 31, 2008. The rate of positivity was 24.2% during period 1, and 11.6% during period 2 (P<0.001). Repeat CDTT was performed 619 times on samples received on the same day as the initial specimen, and only three (0.5%) were discordant. A total of 1630 samples were retested within one to seven days of a negative result, and 103 (6.3%) tested positive (7.8% period 1 and 2.9% period 2; P=0.002). The likelihood of a positive result on repeat testing in the first three days after a negative result was low (0.9%, 7% and 4%, respectively). The cumulative positivity for repeat testing performed in the first three days was 0.9%, 3.3% and 3.5%, respectively, and did not differ significantly at day 3 during the period of high CDTT positivity (P=0.110).CONCLUSIONS:
The value of repeat CDTT, performed using a cell cytotoxicity assay, was low in the first three days after an initial negative result and was unchanged during a CDAD outbreak. 相似文献19.
Clostridium difficile is the commonest cause of hospital acquired diarrhoea in adults and is associated with significant mortality and morbidity. The clinical significance of C. difficile in children, however, is less certain. In this article we discuss colonisation and infection and describe C. difficile in childhood in terms of risk factors, epidemiology and management. 相似文献